6 32. During yur mst recent pregnancy, did any f these peple physically abuse yu? Check all that apply. My husband r partner A family r husehld member ther than my husband r partner A friend Smene else Please tell us: N ne physically abused me during my pregnancy -- G t questin During yur mst recent pregnancy, wuld yu say that yu were physically abused mre ften, less ften, r abut the same cmpared with the 12 mnths befre yu gt pregnant? Check nly ne. I was physically abused mre ften during my pregnancy I was physically abused less ften during my pregnancy I was physically abused abut the same during my pregnancy N ne physically abused me during the 12 mnths befre I gt pregnant The next questins are abut yur labr and delivery. 34. When was yur baby due? 35. When was yur baby brn? _/_/_ mnth day year _/_/_ mnth day year 36. When did yu g int the hspital t have yur baby? _/_/_ mnth day year I did nt have my baby in a hspital 37. When yu had yur baby, hw many nights did yu stay in the hspital? Nights I did nt stay vernight in the hspital I did nt have my baby in a hspital 38. When yur baby was brn, hw many nights did he r she stay in the hspital? Nights My baby did nt stay vernight in the hspital My baby was nt brn in a hspital 39. When yur baby was brn, was he r she put in an intensive care unit? N Yes I dn t knw 40. Hw was yur delivery paid fr? Check all that apply Medicaid Persnal incme (cash, check r credit card) Health insurance Indian Health Service (IHS) Other Please tell us:

7 41. Is yur baby alive nw? N---> When did yur baby die? / / mnth day year Yes ---> Is yur baby living with yu nw? N Yes If yur baby is nt alive r is nt living with yu nw, g t questin Fr hw many weeks did yu breast-feed yur new baby? Weeks I didn t breast-feed my baby ---->G t Questin 44 I breast-fed less than 1 week---->g t Questin 44 I m still breast-feeding 43. Hw many weeks ld was yur baby the first time yu fed him r her anything besides breast milk? Include frmula, baby fd, juice, cw s milk r anything else. Weeks My baby was less than ne week ld I haven t fed my baby anything besides breast milk 44. Abut hw many hurs a day, n average, is yur new baby in the same rm with smene wh is smking? Hurs My baby is never in the same rm with smene wh is smking. 45. Hw d yu put yur new baby dwn t sleep mst f the time? Check ne answer. On his r her side On his r her back On his r her stmach 46. Hw many times has yur baby been t a dctr r nurse fr rutine well baby care? Dn t cunt the times yu tk yur baby fr care when he r she was sick. It may help t use the calendar. Times My baby hasn t been fr rutine well baby care----->g t Questin When yur baby ges fr rutine well baby care, where d yu take him r her? Check all the places that yu use. Hspital clinic Health department clinic Private dctr s ffice Cmmunity health clinic Other Please tell us: The next questins are abut yur family and the place where yu live.

First, we would like to ask you a few questions about the time before your new baby was born. Please check the box next to the best answer. 1. Before your new baby, did you No- Go to Question 4 ever have

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